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Endoscopic management of CSF rhinorrhea
Published in Jyotirmay S. Hegde, Hemanth Vamanshankar, CSF Rhinorrhea, 2020
Jyotirmay S Hegde, Hemanth Vamanshankar
Positive pressure ventilation carries a high risk of pneumocephalus. Hence, while administering anesthesia, it is advisable to perform rapid sequence intubation and minimize masking the patient and using positive-pressure ventilation.
Preanesthetic evaluation
Published in Hemanshu Prabhakar, Charu Mahajan, Indu Kapoor, Essentials of Anesthesia for Neurotrauma, 2018
Julia Martinez Ocón, Ana Ruiz Pardos, Ricard Valero
If the patient is not intubated and requires urgent surgery, it is important to remember that the TBI patient is thought to have a full stomach. In addition to this, it is essential to be ready for the possible presence of blood or vomit in the oral cavity. Finally, TBI often goes along with cervical spine injury, and this possibility must always be considered when performing endotracheal intubation in TBI patients. Rapid sequence intubation is recommended with adequate sedative or analgesics, as well as a neuromuscular blocking agent to prevent increasing intracranial pressure during intubation.
Esophageal Foreign Bodies
Published in John F. Pohl, Christopher Jolley, Daniel Gelfond, Pediatric Gastroenterology, 2014
Children with witnessed button battery ingestion should have immediate radiographs to assess for battery location. The confirmation of esophageal location should lead to immediate endoscopic removal in an operating room with surgeons and cardiovascular surgeons on standby. If the child has recently ingested food or liquids, rapid-sequence intubation should be used to secure the patient airway prior to removal. Delay in the administration of anesthesia is unacceptable as time is likely a critical factor in determining the severity of battery-induced esophageal injury.
Continuum of Care: A Multiagency Approach to Seamless Warmed Prehospital Whole Blood Resuscitation of a Patient with Noncompressible Truncal Hemorrhage
Published in Prehospital Emergency Care, 2023
Thaddeus J. Puzio, David E. Meyer, Nicolas Heft, Wren Nealy, Lesley Osborn
While proximity to Level I or II trauma centers and transportation time are key factors in survival, another critical element is the early administration of balanced blood products. Trauma patients who present to prehospital personnel or the emergency department with a shock index (heart rate divided by systolic blood pressure) > 0.9 have a significantly higher mortality rate and requirement of massive transfusion (1, 2). In these patients, early prehospital transfusion can sustain life and enable rapid transport to definitive management in the OR (3). While the optimal use of whole blood in the resuscitation of hemorrhagic shock remains undefined, early retrospective data show equivalent or improved resuscitation using less overall blood product and similar rates of transfusion-related adverse events (4, 5). Moreover, rapid sequence intubation in the presence of hemorrhagic shock can be dangerous. Induction medications may exacerbate hypotension, and systolic hypotension prior to intubation is independently associated with postintubation cardiac arrest (6, 7). Because of the dangers associated with intubation in hemorrhagic shock, many trauma surgeons have advocated for emphasizing circulatory management before airway management in such patients (i.e., placing Circulation before Airway in the primary survey ABCs) (8). The targeted resuscitation with blood products prior to intubation by the ground EMS crew may have also helped to avoid a deleterious outcome during a high-risk intervention.
Evaluation of Physiologic Alterations during Prehospital Paramedic-Performed Rapid Sequence Intubation
Published in Prehospital Emergency Care, 2018
Robert G. Walker, Lynn J. White, Geneva N. Whitmore, Alexander Esibov, Michael K. Levy, Gregory C. Cover, Joel D. Edminster, James M. Nania
Rapid sequence intubation (RSI) of severely ill or injured patients is a critical intervention performed in various emergency care settings, including the out-of-hospital environment. Although RSI facilitates definitive airway control to protect against aspiration and establish adequate oxygenation and ventilation, the procedure also creates a risk for significant peri-intubation physiologic alterations including oxygen desaturation, cardiac dysrhythmias, and significant hemodynamic changes (1, 2). Such physiologic derangements have been associated with increased morbidity and mortality in patients with some types of acute pathology (3–8), and can increase the risk of peri-intubation cardiac arrest in unstable patients or patients with comorbidities (1, 9, 10). Consequently, prehospital RSI remains a subject of controversy and is presently outside the scope of practice in many North American EMS agencies (11).
Video laryngoscopy-assisted tracheal intubation in airway management
Published in Expert Review of Medical Devices, 2018
Chia-Chih Liao, Fu-Chao Liu, Allen H. Li, Huang-Ping Yu
Rapid airway establishment is a major issue in emergency settings. Successful tracheal intubation in these settings requires a range of expertise resulted from continuous training and practice, and familiarity with airway devices. The rapid sequence technique is designed to facilitate rapid tracheal intubation in patients with an increased risk of gastric regurgitation and pulmonary aspiration. The procedures of the technique include pre-oxygenation, inducing rapid loss of consciousness followed by succinylcholine administration, application of cricoid pressure, and prevention of positive pressure ventilation. The main objective of this technique is to minimize the duration between the loss of airway reflexes and successful intubation with a cuffed endotracheal tube [68]. Rapid sequence intubation is widely practiced in patients with a full stomach or bowel obstruction and women who are pregnant [69].